Lee H. Igel is a teacher and researcher focusing on decision-making and behaviors at work in the sports business. He uses sports as a starting point for exploring questions about business, politics, and society. Igel began his teaching career at New York University, where he is now a clinical associate professor at the NYU School of Professional Studies Tisch Institute and a co-director at NYU Sports & Society. Prior to arriving at NYU, Igel served as program advisor to senior executives of large corporations and professional service firms, entertainers, and elite competitive athletes at La Palestra in New York. Before that, he trained in the sports medicine/player development department of a Major League Baseball club. In addition to his contributions to Forbes.com, Igel's research can be found in industry and social science journals, reference books, and the popular press.

Ex-NFL Players Lawsuit Over Use Of Painkillers: Who Is Ultimately Responsible?

Perhaps you work in an office. If you were badly injured at work and your company doctor told you there was a drug that could put you right back at your desk, would you take it? If you’re like most people the answer is “maybe.” You would probably have a few questions about this drug. But if your work takes place between end zones rather than cubicles, you’d be far more likely to do whatever it takes to get back to work as soon as possible.

The decision to return to the field using any means necessary is at the heart of a new lawsuit that involves more than 500 retired NFL players. They are accusing the league of encouraging a culture in which team physicians and trainers regularly supplied them with drugs to help speed-up their return to the field following injuries. The suit also alleges that those drugs, mainly a smorgasbord of painkillers, were administered to the players without proper prescriptions or warnings about many possible serious side effects. Now, years later, the players say that they’re feeling the pain in the form of heart, lung, and nerve dysfunction, kidney failure, muscle and bone disfigurement, and substance abuse and addiction.

Many people might hem and haw as they weigh the effects of seeking treatment for any serious injury on their lives and livelihood. You would likely ponder what health effects are involved in taking a drug to ease the pain, the potential for long-term side-effects, and how quickly you want to return to work. The majority of professional football players are decidedly not among that group. Their default thinking almost as a rule tends toward how quickly they can get back out on the field—whatever the price.

In recent comments to the Associated Press, former pro lineman Kyle Turley said, “Obviously, we were grown adults and we had a choice. But when a team doctor is saying this will take the pain away, you trust them.” Another recently-retired player, Jeremy Newberry, said that he took the drugs because he felt that playing through pain and injury increased the likelihood that he’d be able to keep his roster spot.

Athletes and teams want to win. That desire often requires players returning to play within as rapid a time frame as possible. So, who is to provide the ballast when the player says to do whatever it takes to get him back in the game?

Team doctors and trainers have a significant role in making that happen. They can subscribe to the ethos of winning and honoring the choices of athletes who wish to return to their sport as soon as is possible. But they have to balance that with the responsibility to promote athlete health and well-being, which often means they should err on the side of caution in responding to health risks and preventing further injury or reinjury. It’s a challenge that is tough when the coach is peering over your shoulder and when roster spots change if a player is in the training room more frequently than on the field.

Winning and getting injured players back onto the field as as quickly as possible are two goals that can be at odds with one another. And if that is not enough, consider that athletes, team executives, and medical staff members may try to advance those goals simultaneously, which raises further confusion about roles and responsibilities. Conflicts of interest are sure to arise.

One entry point for understanding why this occurs may lie in what George Loewenstein, who teaches economics and psychology at Carnegie Mellon University, calls the “hot-cold empathy gap.” People often “mispredict” how they and others will think, feel, and behave across different affective states. In “cold” states, when people anticipate some future condition and are unemotional, they underestimate preferences and behaviors that they would have in the actual future condition. In “hot” states, when people are sufficiently psyched-up and in the moment of the actual condition, they underestimate the influence the state has on their preferences and behaviors; as a consequence, they overestimate the stability of those preferences and behaviors. Put another way, imagine a decision-making process that might be transpire between an athlete, team officials, and medical staff members in a training room on an off-day versus a game day.

Like most human beings, professional athletes prioritize short-term gratification while discounting long-term consequences. The pressures associated with getting back on the field as soon as possible can compromise safe treatment protocols. They can also expose players to a number of potential health risks.

Protocols for treatment of injury that were acceptable years ago may not be acceptable today. That will hold true in the future, as well. The practice of medicine changes when advancements are made in our understanding of the science underlying it.

In the latest lawsuit to hit the NFL, the basic question is whether NFL players were properly informed about the drugs they were being administered. There is also some question about whether they felt compelled to consent to the treatments because of the nature and culture of their workplaces. But the biggest question is: Who should be charged with thinking for the long-term, since players may only be thinking about what they need to do now to get back on the field as soon as possible? That is where responsibility for thinking long-term lies.

Arthur L. Caplan, PhD, is the Drs. William F. and Virginia Connolly Mitty Professor and head of the Division of Bioethics at New York University Langone Medical Center. Lee H. Igel, PhD, is associate professor in the Tisch Center at New York University. Both are affiliated with NYU’s Sports and Society Program.

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